Journal List > J Korean Assoc Pediatr Surg > v.22(2) > 1071967

Jeong, Kim, Jung, and Choi: The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease

Abstract

Purpose

Hirschsprung’s disease (HD) is a congenital intestinal disorder with absence of ganglion cells in the intestinal muscle and submucosa. Diagnosis is based on histopathological study such as H&E, and acetylcholinesterase (AchE) immunohistochemistry. Calretinin immunohistochemistry was introduced as a new diagnostic method against limitations of other staining. The aim of this study is to investigate the usefulness of calretinin immunohistochemistry for the diagnosis of HD compared to H&E and AchE.

Methods

Ten patients with HD and 22 non-HD patients were included in the study. H&E staining, AchE and calretinin immunohistochemistry were performed in all 32 patients. All slides were evaluated by same single pathologist and the diagnostic value was calculated for each H&E stain, AchE immunohistochemical staining, and calretinin immunohistochemical staining.

Results

Calretinin method had sensitivity of 100% and specificity of 100% for diagnosis of HD. Its diagnostic accuracy was 100%. AchE staining showed 100% of specificity and 80% of sensitivity. Diagnostic accuracy of H&E staining was 56.3%.

Conclusion

We concluded that calretinin immunohistochemistry is a very useful and valuable method to diagnosis HD patient.

Figures and Tables

Fig. 1

Hirschsprung’s disease (HD) case shows diffuse proliferation of acetylcholinesterase (AchE) fibers (arrows) in lamina propria, muscularis mucosa, and submucosa (A), but complete absence of calretinin immunoreactive fibers (C). Non-HD case reveals many thin calretinin immunoreactive fibers (arrows; D), but no proliferation of AchE fibers (B). (A, B) AchE stain, ×100. (C, D) Calretinin stain, ×100.

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Fig. 2

Hirschsprung’s disease case shows equivocal acetylcholinesterase (AchE) findings which have mild proliferation of AchE fibers in submucosa (A, B; AchE stain, ×100), but complete absence of calretinin immunoreactive fibers was observed (C, D; calretinin stain, ×100). This case is difficult to differentiate diagnosis for normal variation.

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Table 1

Patient Profile

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Table 2

Results of Calretinin Immunohistochemical Staining

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Sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100%, accuracy 100%, p<0.001.

Table 3

Cases of Repeated Biopsy

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Table 4

Results of Acetylcholinesterase (AchE) Immunohistochemical Staining

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Sensitivity 80%, specificity 100%, p<0.001.

Table 5

Results of H&E Staining

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p=0.035.

Notes

The content of this article was presented at the 30th Annual Meeting of the Korean Association of Pediatric Surgeons, Busan, June 2014.

CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported.

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